Pelosi: Time to know where caucus stands on public healthcare option

Speaker Nancy Pelosi (D-Calif.) on Thursday told fellow Democrats the time has come for all members of the party to say where they stand on the government-run health insurance program.

Pelosi informed her caucus that she will be asking which of the various public options members can support, or if they cannot support any at all.

The nose-counting effort will involve the Democratic whip operation, the Congressional Progressive Caucus and Pelosi herself, according to members who attended the Democrats’ closed-door caucus meeting Thursday.

Once she has a better idea, Pelosi can decide on which public option to include and then bring the healthcare legislation to the House floor for a final debate.

“She said essentially, ‘It’s decision time. I need to know,’ ” said Rep. Gerry Connolly (D-Va.).

Pressure is building on Pelosi to pick a plan and move forward, now that the Senate has completed its committee work on two bills and is gearing up for a floor debate in less than two weeks.

For the second consecutive day, Senate Majority Leader Harry Reid (D-Nev.) met behind closed doors with Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Chris Dodd (D-Conn.) of the Health, Education, Labor and Pensions (HELP) Committee, along with White House Chief of Staff Rahm Emanuel and other White House aides.

Reid and the committee representatives also briefed the entire Democratic Conference and took questions during a lunch prior to the meeting. No decisions have been made about divisive issues such as the public option or how to finance the new spending in the healthcare reform bill, senators indicated. The talks between Reid, Baucus, Dodd and the White House will resume next week, as Reid planned to return to Nevada to campaign on Thursday.

“We all know this is the most important piece of legislation we will ever pass since the Great Depression,” Baucus said. “This is more important than Medicare. This is more important than Social Security. Healthcare reform is something that touches all Americans in many, many ways.”

Baucus’s bill, approved by the Senate Finance Committee this week, does not include a public option, while the HELP bill has one. Key centrists in the chamber say Reid lacks the necessary 60 votes to advance a bill with a public option.

Pelosi has said that any healthcare legislation Congress passes must have a public option, despite signals from the White House that it could live without one.

On Thursday, Pelosi outlined several variations beyond the plan favored by liberals. The differences turn on how providers will be reimbursed. Liberals want rates tied to Medicare plus 5 percent. Centrists, many from rural areas that feel shortchanged by Medicare, want the government to negotiate individually with providers, an approach commonly called “negotiated rates.”

The variations include making it a fallback option that could be triggered if insurance isn’t affordable — an idea that is gathering momentum in the Senate — increasing the number of people covered by Medicaid and raising hospital reimbursement rates. The different options were sent to the Congressional Budget Office to see how much each would cost or save.

The results are expected by Tuesday. With numbers in hand, members will be asked to commit, so that leaders can get an idea of what approach will get the 218 Democratic votes needed to pass the bill.

“People will be asked to pick among that smorgasbord in a couple of days,” said Rep. Robert Andrews (D-N.J.).

Pelosi may not get Rep. Mike Ross (D-Ark.), a Blue Dog member who made headlines by rejecting a compromise he’d negotiated on a public health insurance option. But on Thursday, Ross opened the door a little to making his vote attainable, suggesting to Democratic leaders that the government-run Medicare program be opened to those without insurance.

Ross also brought the idea to the closed-door House Democratic Caucus meeting Thursday.

“I — speaking only on behalf of myself — suggested one possible idea could be that instead of creating an entirely new government bureaucracy to administer a public option, Medicare could be offered as a choice to compete alongside private insurers for those Americans eligible to enter the national health insurance exchange, but at a reimbursement rate much greater than current Medicare rates,” Ross said in a statement to The Hill.

But Ross said he would want reimbursement for providers to be at a “much greater rate” than it is now. Medicare reimbursement rates have been a sore point for rural lawmakers who feel that Medicare shortchanges their hospitals.

His statement went on to say that he does “not support a government-run public option” and does “not endorse this idea” of opening up Medicare. He said he is looking for solutions in the healthcare debate.

While the public option has been the highest-profile question for House Democrats in the healthcare debate in recent weeks, once it is resolved they will still face a host of thorny issues. There are members who strongly support a public option, but oppose the income surtax on the wealthy that Pelosi wants to use to subsidize care for the poor and the middle class. Whether the healthcare overhaul addresses abortion and illegal immigrants also loom large.

House Majority Leader Steny Hoyer (D-Md.) has said he doesn’t expect the vote to take place before the first week of November, which means it might not come until just before the Thanksgiving recess.

Jeffrey Young and J. Taylor Rushing contributed to this article.